by Mavis Gallant
Standard Staff Writer
Doctors take an oath to save life; when that’s impossible, should they make death easier?
Next week in New Hampshire, Dr. Hemann N. Sander will be tried for the murder of Mrs. Abbie Borroto, an incurable cancer patient whose death he allegedly hastened by injecting air into her bloodstream.
Even if he is proved responsible, one question will not have been settled for many people: “Was he morally guilty?”
After decades of debate, we are no nearer to a solution than we were in the 16th century when Thomas More made euthanasia part of Utopian society. It was practised under Roman emperors. Sparta carried on mass euthanasia in order to breed a race of fighters, and in so doing denied herself progress in art and science.
Methods of euthanasia have altered through the centuries. In Brittany, it was once carried out by hitting the patient over the head with a special stone hammer kept in the village church. The Scots had a similar method of quickening the death of the aged, although they added to the ceremony by bawling a little verse through the keyhole which began, “Will you come or will you go?” and which was repeated three times.
When the Nazis, who developed mass euthanasia to an efficient and organized degree, wanted to clear out their hospitals for the chronically ill, they first tried poison (once suggested by Francis Bacon). Then resorted to air in the bloodstream because it was cheaper. And many of the doctors who took part in these actions have since been tried and condemned for crimes against humanity.
But, of course, death for the good of the state is not at all what most people mean by euthanasia. The term itself is almost self-explanatory; it is from the Greek, “eu,” meaning “well,” and “thanatos,” which means “death.” And most of the advocates of euthanasia want it legally in force in order to prevent, rather than create, suffering.
Since the beginning of this century, it is an issue which has been wrangled, in and out of print, almost unceasingly. The arguments on both sides have not changed. And neither side has given an inch.
Sometimes, for months and years, the arguments simmer under the surface of public attention, confined to pleadings pro and con, in medicals journals, or reports of proceedings of euthanasia societies on both sides of the Atlantic. It takes a shocking human crisis to remind people that euthanasia is being carried out, that it is not legal, but that it is condoned in spirit by a large section of the population.
It is carried on in hospitals. It is practiced by next-of-kin (who almost invariably get caught) and by doctors (who usually don’t). Some of the most controversial cases do not involve more than one person.
Fifteen years ago, for example, an American woman called Charlotte Perkins Gilman, dying of incurable cancer, killed herself with chloroform. The verdict of the coroner’s jury, in spite of the protests of her husband, was suicide while of unsound mind.
Many people agreed with the verdict. But the proponents of mercy killing had another term for it: self-euthanasia. Mrs. Gilman, they said, was sane. She had done what should have been done for her, and which should have been legal. She left a letter, painfully typewritten before her death, explaining “why I have preferred chloroform to cancer.” It was widely reprinted and became one of the strongest arguments for the pro-euthanasia groups.
No one, wrote Mrs Gilman, had the right to commit suicide for selfish reasons or such maudlin considerations as a broken heart. Life consisted, in the main, of service to others. As long as you could be useful, you should stay alive. But when death was inevitable and a useful life out of the question, “it is the simplest of human rights to choose a quick and easy death in place of a slow and horrible one.”
Some day, she felt, society would have reached the point where it would not allow “a human being to lie in prolonged agony which we should mercifully end in any other creature.”
After Mrs. Gilman’s death, a public debate raged for months. The old unchanging arguments were revived, aired, fought and dropped from the public press until the next crisis. In the eyes of the law, she had died by an unlawful act. In the eyes of the Roman Catholic Church, she had died in mortal sin.
The church is immovably opposed to mercy killing under nay circumstances. It holds that life is given by God and can be taken only by Him, and that suffering is part of His will. The Vatican stand was reiterated in 1940, when 85,000 persons who were aged, blind, or chronically ill were put to death in Germany. The killing of the weak for racial ends was “contrary to natural and positive divide law,” and the following year, Racialism and Christianism, a German book which dealt in part with mercy killing, was put on the forbidden list. The official Vatican publication called it “brutal paganism,” the term recently used by Archbishop Cushing, of Boston, in response to increased agitation for legalized euthanasia.
The same stand was put unofficially and more simply by Dr. James J. Walsh, a prominent American physician, shortly after Mrs. Gilman’s death. He had seen many dying cancer patients, he wrote. Few of them wanted to die, and those who did were usually neurotic. They were suffering “not pain but the yielding to self-pity.”
“They know,” he explained, “that there were times in their life, moments of weakness, when they allowed themselves to be overcome by evil…They recognize that they deserve some punishment for these slips from grace and they become persuaded that their pain may represent that punishment…”
Other doctors would not agree. One of these, writing in the Medical Record a few years later, commented on his “feeling of stark impotence” as he dealt with patients “really more dead than alive and begging the doctor to end it all. Both the law and his code demand that he stand by, helpless and hopeless.”
But many doctors have “done something” and have admitted it, despite the Hippocratic oath: “To please no one will I prescribe a deadly drug nor give advice which may cause death.” One startling case involves the famous Pasteur.
Six Russians, who had been bitten by mad wolves, were sent by the Czar to the Pasteur Institute in Paris. A week later they were still alive, although in great pain. Finally, one by one, they began to go mad and it was obvious to Pasteur and his colleague, Tillaux, that nothing could be done for them. During the night, the story goes, “euthanasia was practiced” and neither Pasteur nor Tillaux was arrested.
Three years ago Dr. E. A. Barton, retiring after 40 years’ practice in London, England, announced that euthanasia was practised and added, “I am not ashamed to say I have done so.”
Also in England, in 1939, Sir James Purves-Steward told the Voluntary Euthanasia Legalization Society about one of his patients, a woman dying of cancer. He did not say what he had done, but merely admitted that one morning she had mercifully failed to waken. Ten years ago, at a meeting of the Medico-Legal Society in Britain, Dr. Kenneth McFadyean reminded the group of something he had already said on a public platform: that euthanasia was carried on by the medical profession and that he himself had been practising it for 20 years.
Recently there has been another open confession. Dr. A. L. Goldwater, a New York physician, told the Euthanasia Society of America that he had occasionally given patients who were suffering intense pain, and who were incurably ill, large doses of morphine, telling them frankly: “If you take the whole bottle you won’t wake up.”
“If that be murder,” he added, “then make the most of it.”
A parallel can be drawn here to a custom of the Eskimos known as “aided suicide.” With the blessings of medical knowledge often not available to them, Eskimos still practise to some extent the custom of helping the aged and incurable to die, if they request it. They are, however, liable to be tried and punished under Canadian law if they do so. The sentences are usually light, by our standards.
One of the strongest arguments against euthanasia is that it would restrict medical research. If incurable cases could be so readily disposed of, why bother trying to find the cause and cure of the disease? In 1903, for example, the New York State Medical Association asked its members if a doctor had the right to kill for cancer in certain cases, tuberculosis “at the hectic stage,” and paraplegia.
Cancer is still debatable. But we know today that tuberculosis can often be cured, and that paraplegics can live useful and not unhappy lives. Supposing permission had been obtained? Would doctors still be killing TB patients and paraplegics as “incurable” or would present-day progress have been made at all?
No one can answer with certainty. Yet, as Dr. A. L. Wolbarst, an American physician who has written and spoken for the cause of euthanasia, has pointed out, a miracle cure is too late for a person already dying.
“We are told that it would be unwise and inhumane to administer euthanasia to a patient dying from metastatic cancer,” he wrote, “because a cure for cancer might be found ‘tomorrow.’ Of course, that is possible…but such a cure, if and when it is discovered, will be of little if any value to the man of woman so far advanced in cancerous toxaemia as to be an applicant of euthanasia.”
The medical profession itself is divided on the subject. Many doctors feel that too much responsibility – and possibly stigma – would be placed on the profession, and they ask the not-unnatural question: “Why me?” Again, the suggested procedure for legal mercy killing, which involves the patient’s consent, boards of inquiry and state approval, seems to them too cumbersome.
Many doctors would probably rather go along with the remarks of the Archbishop of Canterbury during a debate in the House of Lords on the subject. Exceptional cases were morally legitimate, he said. But the medical profession must exercise its own judgment rather than have the situation “dragged into the open and regulated by elaborate legal procedure.”
Another religious opinion was expressed by William Ralph Inge, Britain’s Gloomy Dean, who wrote flatly: “Euthanasia should be permitted but only in very exceptional cases.”
Until very recently, the peak of interest in and pressure for legal mercy killing was in the mid-1930s. In England, in 1935, a “Right to Die” drive was pushed. A famous surgeon, Lord Moynihan of Leeds, became president of the Voluntary Euthanasia Legalization Society. A mercy killing bill, for which he worked tirelessly, was bitterly debated in the House of Lords and thrown out. Lord Moynihan died suddenly before the debate took place; and shortly afterward, while the pros and cons were still being fought, World War II broke out, which rendered ironic any discussion of mercy-deaths.
At the same time, a society was also being formed in the United States. The leader was, and still is, Dr. Charles Francis Potter, leader of the Humanist Society, who said, referring to the Commandment “Thou shalt not kill” : “Perhaps the time has come to forget Moses and listen to the words of Jesus, “Blessed are the merciful.”
After the war, societies on both sides of the Atlantic revived. Four years ago, 54 prominent Protestant clergymen in New York aproved “under careful safeguards” the idea of mercy killing. The American Council of Christian Churches promptly declared it contrary to the command of God. The same year, a bill was introduced in the New York State Legislature, backed by 1,500 physicians.
A heated debate resulted between Dr. Potter and Msgr. Robert E. McCormick, presiding judge of the Eccleslastical tribunal of the New York Roman Catholic archdiocese. The Monsignor called euthanasia “medical murder” and pointed out, the paradox between legal mercy killing and the trials of the Nazi doctors, then going on. The line between voluntary and involuntary death might become very slight, he felt.
Last year, a group of Protestant and Jewish clergymen in New York again asked for a stat law. Mercy killing again would be undertaken only after a request from the sufferer and approval by a court, following investigation by a court-named committee. Among the backers were Henry Sloan Coffin, president emeritus of the Union Theological Seminary, and Harry Emerson Fosdick, minister emeritus of Riverside Church New York.
Not all Protestants were in agreement. The resolution was condemned by, among others, the Lutheran Syndical Conference.
Today, however, feeling is perhaps stronger than it has ever been. The United Nations has been asked to include the right of merciful death in the Declaration of Human Rights. Friends and patients of Dr. Sander in New Hampshire, far from condemning him, have rallied to his support. The same is true of Carol Paight, the 20-year-old Connecticut girl who shot her father in his hospital bed because she did not wish him to suffer for six months before an inevitable death from cancer.
If euthanasia should be legalized, even if it is only in one state of the USA, the rest of the world will be interested in seeing how some of the problems are worked out. For instance, what about life insurance? Would and insurance company consider mercy killing death from a natural cause? What about public patients in municipal hospitals? It might increase the fear already held by many of the uneducated and underprivileged people that a hospital is a place where they kill you.
What about patients who are mentally unfit to give consent? And paralytics who cannot? And infants? And those under 21? If consent is to rest with the patient, is a patient to be roused from a narcotics-induced sleep and asked if he would like to die now? If consent is not required, what about malformed and idiotic children?
There is also the definition of “intolerable” pain. What is unbearable for one patient may not be so for another. Again, there is always the chance that a dying patient might request euthanasia, although his will to live might still be strong, simply to stop being a burden on his family. And there is always the possibility of family pressure.
The opposition will also have some questions to answer, and one of them has been put by Dr. Potter. “We do not approve of murder,” he said, “but the state gives us the right to kill in war; and the state kills in capital punishment and we can kill in self-defence. Why not add a fourth reason – mercy?”
– Montreal Standard, February 18 1950.